Healthcare Provider Details

I. General information

NPI: 1053090845
Provider Name (Legal Business Name): GABRIELLE JANDREAU MSOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 MAIN ST STE 11
PRESQUE ISLE ME
04769-2270
US

IV. Provider business mailing address

744 MAIN ST STE 11
PRESQUE ISLE ME
04769-2270
US

V. Phone/Fax

Practice location:
  • Phone: 207-227-5855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT4500
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: